Helping communities make the most of opioid settlement funds

David Evans, a veteran paramedic and medical officer for the Beaufort/Port Royal Fire Department, goes beyond the basics when it comes to caring for the people in his community. He’s paid with a grant the county got for opioid abatement through a legal settlement. So his job includes dealing with one of the bigger challenges of our time: the scourge of drug addiction.

“I have to educate people about the opioid crisis. I’m trying to teach them what to look for, how to treat it, where to get Narcan if they know anyone who needs it, plus where they can seek actual treatment centers and things like that.”

That information is badly needed, Evans said. “It's not really well known, from what I've seen. We also help them understand why some people don't seek treatment and how we can remove some of the stigma to try to encourage them to get treatment.”

 

Funding for that work comes from the South Carolina Opioid Fund from the 2022 National Opioids Settlement and future settlements – money that comes from companies paying the price for their roles in the opioid epidemic.

The toll that epidemic has taken is staggering. According to the Centers for Disease Control and Prevention, 220 people a day died from opioid overdoses in 2021. Three years later, opioids are still a huge problem. These days, the synthetic opioid fentanyl is the United States’ biggest drug threat, according to the Drug Enforcement Administration. So the problem isn’t going away on its own. 

But communities have help in their efforts to solve it. That’s where the South Carolina Center of Excellence in Addiction comes in. It’s a collaboration involving the Medical University of South Carolina, Clemson University, the University of South Carolina, the state Department of Alcohol and Other Drug Abuse Services and the state Department of Public Health. Evans and other front-line addiction specialists get training through the center’s Project ECHO (Extension for Community Healthcare Outcomes).

Psychiatrist and nationally renowned addiction researcher Kathleen Brady, M.D., Ph.D., of MUSC, is one of five experts on the center’s leadership team. “As new abatement settlements and, potentially, other addiction-related funding sources like federal grants and foundation opportunities, come into the state, the COE is poised to provide locally informed consultation and technical support for South Carolina leaders and organizations to ensure that every dollar has a maximal community impact,” Brady said.

She said the Center of Excellence has focused resources in three key areas that will be expanded over time. They include:

Leveraging existing data to inform and enhance effective service delivery

At the heart of the center’s mission is the recognition that decisions about distributing funds and guiding agencies in preventing addiction must be based on data. These are not simply good-sounding ideas with no science behind them but processes and procedures founded in facts.

For example, Brady said the center has developed the evidence-based Opioid Use Disorder Treatment Performance Measurement System to determine how well systems are faring when it comes to identifying and treating people with opioid use disorder.

“It consists of four domains: The diagnosis/identification of opioid use disorder; engagement in treatment; getting medications, such as naltrexone, buprenorphine and methadone, to people who need them; and keeping people in treatment and recovery for as long as they need,” Brady said. 

Freely sharing that information is part of the plan. “County-, regional- and state-level reports are being produced for public dissemination so people can see the work that’s being done.”

Supporting opioid abatement through technical assistance and clinical support

Brady said the center also offers agencies technical aid to help them navigate what can be complex areas. “Local leaders and their community partners can request technical assistance through a form on the COE website or via direct email to camhr@clemson.edu.”

Clinical support is part of the effort, too. Brady said doctors and other health care providers who work with patients suffering from addiction can access real-time support by calling a free “warmline” at 864-914-1301. “That has the dual benefit of improving care outcomes while supporting and educating frontline clinicians.” 

Providing training to enhance understanding of opioid use disorder and evidence-based abatement strategies

The phone isn’t the only way the center makes connections. Brady said it also holds trainings on the second and fourth Fridays of the month at noon for all South Carolina counties, municipalities and their abatement partners. 

“Project ECHO: South Carolina Community Opioid Response Initiatives, or CORI, is a great way to connect local leaders with addiction experts and each other to learn about the most impactful community strategies and how to implement them. Each session includes an opportunity for a community participant to present a local abatement strategy project or an idea of interest for discussion followed by a brief, relevant lecture,” Brady said.

Recent lecture topics have included “Minding the Gaps: What’s Missing in Harm Reduction: Understanding Your System and Establishing Unique Partnerships” and “Community-Based Considerations: Medications for Opioid Use Disorder in the Fentanyl Era.” The trainings are free to all relevant people and organizations. For information about joining the ECHO program, email project coordinator Carrie Papa.

Brady also outlined some other points of focus for the center beyond those key areas.

The center’s sustainability

Brady said the Center of Excellence in Addiction, founded in 2023, isn’t going away any time soon. “Bringing together South Carolina-based national experts in addiction science and treatment, the COE is in a position to support work critical to ending the opioid epidemic and address other substance use disorders.”

The center will provide in-depth reporting on addiction-related statistics, issue policy and position statements, plan and implement workforce development initiatives and test innovative strategies to reduce opioid abuse and other substance use disorders.

“In addition to funding from the South Carolina Opioid Relief Fund, we are receiving funding from the state legislature and working on contracts for a number of special projects with Blue Cross Blue Shield, Department of Health and Human Services and other entities,” Brady said.

Avoiding pitfalls other states have dealt with when it comes to using opioid settlement funds  

The kind of big money that comes from opioid settlements can prove challenging for governments to allocate and track appropriately. For example, West Virginia has come under scrutiny for various concerns related to the foundation the state established to distribute funds from multiple settlements.

To try to prevent those kinds of problems, Brady said the South Carolina State Legislature created the South Carolina Opioid Recovery Fund (SCORF) Board, made up of dedicated individuals focused on the opioid epidemic in South Carolina. “The board has published a list of approved strategies, and all distributed funds must use these strategies. The board evaluates and approves each application, and the continuation of funding is contingent on progress reports that demonstrate impact. 

“The board has been approving applications and responsibly distributing funds for over two years and serves as a key mechanism for overcoming the types of hurdles that have been seen in other states.”

The fentanyl factor

Some of those funds are being used to fight fentanyl, a powerful drug that has become part of the fourth wave of the opioid epidemic. The synthetic opiate is much more powerful than heroin or morphine. Drug dealers add it to heroin to give users an intense high. But it’s so potent that it can turn deadly. The DEA has called it a “threat to public health and safety.”

Brady said because of fentanyl’s potency and high prevalence in the drug supply, it presents new challenges. “One of the COE’s goals is to unify the state in combating fentanyl mortality by making it easier to access addiction treatment and recovery resources than it is to access fentanyl in South Carolina.”

That unity will help the center offer early notification to officials about fentanyl hotspots and places where fentanyl contamination in the drug supply is increasing.

Innovative approaches to preventing and fighting addiction

Fighting an evolving epidemic requires leaders to be nimble and collaborative, Brady said. The center allows nationally recognized experts to work together, with financial support, to make real progress in fighting addiction and the toll it takes on communities. “The leadership from the academic centers in combination with the leadership from the state agencies allow us to join forces to innovate and work on initiatives that none of us could do on our own.”

Center’s aid beyond distribution of funds

Brady said the center doesn’t just help with addiction abatement funds but also with any planning or evaluation needs around substance use disorders.

“For example, the MUSC team is currently working with South Carolina hospitals to scale and spread a best practice that MUSC is known for – provision of buprenorphine in emergency department settings.” Buprenorphine can reduce cravings and other symptoms in people going through opioid withdrawal. 

The center also knows how to expand its reach. Three examples illustrate that point. One, the Clemson experts in the center provides technical assistance to Law Enforcement Assisted Diversion sites in the state. Two, the center hosted this year’s Governor’s Summit on Substance Use Disorders. And three, it’s planning next year’s summit.

“The Center of Excellence has the capacity to leverage tremendous expertise that exists across the state and, through the power of collaboration, put that expertise to work in strategic fashion to maximize the impact on reducing addiction in our state,” Brady said.

Back in Beaufort/Port Royal

David Evans, the paramedic and medical officer in the Beaufort/Port Royal area, isn’t on his own when it comes to learning and sharing information about addiction treatment and prevention. He gets training through the center’s Project ECHO. 

“I've met different people in different areas, different careers, things like that, listening to their research, what they do. One talked about pregnancy and opioids and mental disorders, things like that. So that helped me steer me in those directions to look up more information.”

It’s information he’ll pass along to his community, one more person fighting an epidemic that’s already taken far too great a toll.